Maidencreek Place

During a fire drill, the evacuation time was 8 minutes and 6 seconds, exceeding the facility's required 8-minute limit.

A resident glucometer was not calibrated to the current date and time, and there were discrepancies between glucometer readings and the Medication Administration Record (MAR).

The medication administration record for a resident prescribed sliding scale insulin did not indicate the specific number of insulin units administered.

The home failed to report incidents to the department when the fire alarm company dispatched the fire department to the home.

Unannounced fire drills were not conducted during the months of May, June, and July 2025.

Fire drill records were incorrectly documented, including recording educational training as full drills and inaccurate alarm status.

The fire alarm was reported as disabled by the home during a fire drill.

Staff Member A did not complete a fire safety and emergency preparedness orientation on or before their first day of work.

The administrator or designee failed to provide requested witness statements to Department agents during the investigation.

An incident involving a verbal and physical altercation between staff was not reported to the Department within the required 24-hour timeframe.

Residents were not treated with dignity and respect due to a verbal and physical altercation between staff members in a resident's room.

Staff members were identified as Med Techs without documented required Medication Administration Training, observations, or up-to-date training records.

The facility failed to follow prescriber orders for a resident's medication hold parameter and lacked recorded blood pressure readings to verify appropriate administration.

A resident's support plan incorrectly stated they used bilateral hearing aids, which the resident denied and staff were unaware of.

The home lacks a policy outlining the use of bedside mobility devices for residents using bed enablers.

A direct care staff member's personnel file did not contain a required PA background check meeting OAPSA requirements.

The home lacked documentation verifying that a direct care staff member possessed a high school diploma or GED.

Direct care staff members had not received required annual training in topics including dementia care, infection control, and safe management techniques.